New Vendor

Credit Application to be sent to who? *

Vendor Name *

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

DUNS Number *

Member of Unipro *

Federal Tax ID *

Telephone *

Fax

Contact Name *

Comments

Supplier Terms *

## Days

Discount *

Discount Percentage

0-100

Minimum Shipment Amount

Lead Time

Order Day

Delivery Day or Days

Picking Discount

Cut-Off Time

Broker Name

Broker Address Line 1

Broker Address Line 2

Broker City

Broker State

Broker Zip/Postal Code

Broker Telephone

Broker Fax

Broker Cell

Broker Email

Broker Contact Name

Broker Comments

How are orders placed?

Are Confirmations Provided?

If yes, how?

Additional Contact Information

Additional Information